title: Vaginal dilators for prevention of dyspareunia after prolapse surgery: a randomized controlled trial.
abstract: OBJECTIVE
  To compare rates of de novo dyspareunia in women with and without vaginal dilator use after posterior colporrhaphy.
  
  
  METHODS
  This randomized controlled trial included sexually active patients with prolapse and no bothersome baseline dyspareunia undergoing posterior colporrhaphy. Patients were randomized to daily vaginal dilator use from postoperative weeks 4 through 8 or to no dilator use. Pelvic organ prolapse quantification examination and vaginal caliber were measured at baseline, 8 weeks, and 6 months postoperatively. Sexual function was evaluated at baseline, 3 months, and 6 months postoperatively using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12. Participants completed a Patient Global Impression of Improvement at 3 months and 6 months postoperatively.
  
  
  RESULTS
  Sixty patients were randomized: 30 in the dilator group and 30 in the control group. There were no differences in baseline characteristics and postoperative vaginal caliber between groups. At 3 months, 9.5% of patients reported de novo dyspareunia in the dilator group compared with 19.2% of control patients (P=.44). At 6 months, 12.5% of patients in the dilator group reported de novo dyspareunia compared with 3.8% of control patients (P=.34). There was a 13% loss-to-follow-up rate, and therefore we did not meet appropriate power to detect a difference. There were no differences in overall sexual function or Patient Global Impression of Improvement scores between groups at 3 months and 6 months.
  
  
  CONCLUSIONS
  There were no significant differences in de novo dyspareunia rates, overall postoperative sexual function scores, or global improvement scores between those using vaginal dilators compared with control patients.
authors.affiliation: Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center, Washington, DC; and the Departments of Reproductive Biology and Psychiatry, Division of Behavioral Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Danielle D
authors.initials: DD
authors.lastname: Antosh
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gutman
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Park
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Sokol
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Peterson
authors.forename: Sheryl A
authors.initials: SA
authors.lastname: Kingsberg
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Iglesia
mesh_terms: D000328:Adult; D004414:Dyspareunia / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D014596:Uterine Prolapse / Q000601:surgery*